Healthcare Provider Details

I. General information

NPI: 1457949539
Provider Name (Legal Business Name): BEHAVIORAL ENHANCEMENT SERVICES & TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N 7TH AVE STE 115
POCATELLO ID
83201-5786
US

IV. Provider business mailing address

PO BOX 2811
IDAHO FALLS ID
83403-2811
US

V. Phone/Fax

Practice location:
  • Phone: 208-909-5177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEMI ECHI-ABOLI
Title or Position: BILLING DEPARTMENT DIRECTOR
Credential:
Phone: 208-360-1038